Provider Demographics
NPI:1003855586
Name:ULRICH, KATHLEEN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:ULRICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E OGDEN AVE
Mailing Address - Street 2:STE 126
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3633
Mailing Address - Country:US
Mailing Address - Phone:630-325-6133
Mailing Address - Fax:630-325-4751
Practice Address - Street 1:201 E OGDEN AVE
Practice Address - Street 2:STE 126
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3633
Practice Address - Country:US
Practice Address - Phone:630-325-6133
Practice Address - Fax:630-325-4751
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000113231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL90897Medicare ID - Type UnspecifiedIND PROV NUMBER